I know this might not be the correct forum for this question, but after reading many Q&A's on this site, I find you to be the best informed on the widest variety of HIV/AIDS topics.

When we hear about Africa having a whopping 10 of their workforce infected with HIV/AIDS, what exactly does this mean. Is this AIDS illness or is it confirmed HIV positive serostatus based on ELISA/EIA testing?

Do many in Africa test negative for the HIV antibody, but manifest AIDS illness? Do we consider these people to be HIV infected? Do we assume there strain is a variant strain not picked up by the tests?

If it is the case that some 10 of Africa's workforce is infected with this illness one way or another, I need to put something into perspective here. HIV is not a particularly easy virus to catch. 10 boarders on the frequency of EBV or CMV infection in the general western population. I know that lack of circumcision allows for heterosexual men to more easily contract the virus from women, but even so. Are Africans doing it like bunnies over there? I doubt we understand the whole story. In fact, I'm quite certain we understand only a fraction of the reason for HIV's astounding prevalence in Africa and other third world regions.

Do you honestly believe there isn't a very strange feeling to this whole situation? Some kind of missing link? Possibly putting our HIV tests and criteria for what constitutes AIDS illness into question?

Response from Dr. Wohl

We can not look at the global HIV pandemic through the lenses of the West's experience with this virus.

Africa is indeed burning. This is no mistake and to believe so is to risk being considered a denialist. Testing of blood with from blood donors, military personnel, miners, STD clinic patients... the list goes on, confirms that in many places in sub-Saharan Africa 20% or even more are HIV infected.

The reason for the high prevalence of the virus there (nowhere near like CMV or EBV which is more like 90%-100%) is thought to be due to several factors including:

-The HIV virus clade, or strain, in Africa is much more easily transmitted heterosexually than the clade found in the US and Europe.

-Concomitant high levels of sexually transmitted diseases and genital infections (such as bacterial vaginosis) in these countries facilitate the spread of HIV.

-Social turmoil including those brought about by war and famine, poverty and social/cultural practices create the environments in which HIV transmission becomes more likely.

These and other factors differentiate the epidemic there from here. However, in Eastern Europe it is injection drug use, in India it is poverty and commercial sex, in China it is tainted blood products and collection techniques that will make these places the next 'Africa'.

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